Hirsuties Coronae Glandis – Causes, Symptoms, Treatment

Hirsuties Coronae Glandis/Pearly Penile Papules, also known as papillomatosis corona penis, corona capillitii, hirsuties coronae glandis, papillae coronis glands, and hirsutoid papillomas, are benign? lesions of the penis.[rx][rx][rx]

Pearly penile papules (PPP) are painless and benign? lesions that present in rows around the corona of the glans penis in late adolescence or early adulthood. Although asymptomatic, they are often mistaken for sexually transmitted infections such as condyloma acuminata

Hirsuties coronae glandis (also known as hirsutoid papillomas^[rx] and pearly penile papules; PPP)^[rx] are small protuberances that may form on the ridge of the glans of the human penis. They are a form of acral angiofibromas.^[rx] They are a normal anatomical variation in humans and are sometimes described as vestigial remnants of penile spines, sensitive features found in the same location in other primates. In species in which penile spines are expressed, as well as in humans who have them, the spines are thought to contribute to sexual pleasure and quicker orgasms.^[rx][rx] It has been theorized that pearly penile papules stimulate the female vagina during sexual intercourse.^[rx] In addition, pearly penile papules secrete oil that moistens the glans of the penis.^[rx]

Causes of Hirsuties Coronae Glandis

Pearly penile papules are considered normal anatomical variant.[rx][rx]

Penile papules are a normal anatomic variant. They are not due to sexual activity or lack of hygiene. They are not infectious or contagious, unlike genital warts. They are not malignant? or pre-malignant?.

The exact role of pearly penile papules is not clear to date. They might be vestigial of penile snipes, which are seen in primates and other mammals and may promote sexual pleasure.

Symptoms of Hirsuties Coronae Glandis

Pearly penile papules do not cause any other symptoms to develop with them.

Once a man has developed pearly penile papules, they typically remain for life. The growths can fade with age, but they do not tend to change shape, color, or spread further over time. Given the similarity in their appearance to some other conditions, such as genital warts, any men that experiencing other symptoms alongside the growths should seek medical attention.

Other conditions that resemble pearly penile papules include:

• genital warts
• Fordyce spots
• molluscum contagious

For example, growths that begin to itch or cause any discomfort may indicate the presence of an underlying condition that a doctor should examine.

Diagnosis? of Hirsuties Coronae Glandis

History and Physical

Although pearly penile papules are usually asymptomatic, they are often mistaken by males who carry them for genital warts, thus causing concerns of having a sexually transmitted infection?. This fear of infection may cause tense couple relationships, as it raises questions about fidelity within the couple. One study from Singapore showed that approximately one in seven men, who were examined in a sexually transmitted infection clinic, had only pearly penile papules and no infection.

The level of patient concern appears to be related to the size of the papules. According to a study, two-thirds of males with moderate-to-large pearly penile papules have concerns about their lesions, while one-third of those with less-noticeable papules are worried.

Evaluation

Penile pearly papules are flesh-colored or white, dome-shaped or filiform papules. Their size ranges from 1 mm to 4 mm. Pearly penile papules are arranged in rows around the corona of the glans penis, mainly on its dorsal aspect. There can be one row or many rows. The papules may encircle the entire glans and even have ectopic locations on the penile shaft.

The diagnosis?: Differential diagnosis is a list of possible conditions that may explain symptoms. সহজ বাংলা: একই লক্ষণের সম্ভাব্য রোগের তালিকা।" data-rx-term="differential diagnosis" data-rx-definition="Differential diagnosis is a list of possible conditions that may explain symptoms. সহজ বাংলা: একই লক্ষণের সম্ভাব্য রোগের তালিকা।">differential diagnosis? includes genital warts, molluscum contagiosum, lichen nitidus, and sebaceous hyperplasia of the penis.

Genital warts are viral? tumors induced by human papillomavirus. However, no viral particles are found in pearly penile papules. Nevertheless, the coexistence of both conditions may be observed, and genital warts might be seen in about 1% of males with pearly penile papules.

Molluscum contagiosum may be located on the penis as a sexually transmitted infection?. However, these lesions have a larger size and are umbilicated in their center. They rarely have an exclusive location on the corona of the glans.

Lichen nitidus may be limited to the genital area. It manifests as small translucent papules which may involve the glans. However, lichen nitidus lesions are smaller and are usually not limited to the corona of the glans.

Sebaceous hyperplasia is usually seen on the face, but rare cases of penile location were reported. Lesions usually occur on the ventral aspect of the penile shaft and are white to yellow papules.

In the case of diagnostic difficulty, dermoscopy and histopathology are helpful tools.

On dermoscopic examination, penile pearly papules are arranged according to a grape-like or a cobblestone pattern. They exhibit a white or pink color, with central comma-like, hairpin, or dotted vessels. Such a vascular pattern is not specific, as it may be observed in genital warts. However, pearly penile papules, unlike genital warts, do not show desquamation which manifests as an irregular reflection.

Histopathologically, pearly penile papules share the same features as angiofibroma. Microscopic examination shows an acanthotic epidermis, with elongated rete ridges, overlying dilated vessels located in the papillary dermis. There is usually a dermal proliferation of stellate fibroblasts and a marked concentric chronic? injury or inflammation. সহজ বাংলা: অতিরিক্ত দাগের মতো টিস্যু তৈরি হওয়া।" data-rx-term="fibrosis" data-rx-definition="Fibrosis means excess scar-like tissue formation after chronic injury or inflammation. সহজ বাংলা: অতিরিক্ত দাগের মতো টিস্যু তৈরি হওয়া।">fibrosis?.

Treatment of Hirsuties Coronae Glandis

Because of the benign? nature of pearly penile papules, as well as their possible resolution with age, treatment is not indicated. However, some patients feel distressed or have important cosmetic concerns. Furthermore, about a half of males who are reassured of the benign nature of their pearly penile papules want to remove them. Some of them may use inappropriately over-the-counter topicals for common warts, which may cause injuries and scarring.

Pearly penile papules removal is based on physical treatments, namely, cryotherapy and laser therapy.

Studies having assessed cryotherapy are scarce. Two sessions of liquid nitrogen induced good cosmetic results with no pigmentation in a few patients.

Practitioners may also use ablative lasers. Carbon dioxide laser vaporization leads to complete removal of pearly penile papules. This procedure is painful and requires local anesthesia. The vascularization of the penis may cause bleeding during laser sessions but also makes the reepithelialization faster, so that wound healing is achieved within a week. The post-procedure wound management may be inconvenient for patients. Furthermore, there is a risk of scarring and/or pigmentary changes.

Unlike continuous-wave and pulsed modes, fractionated carbon dioxide laser causes less tissue damage with fewer adverse effects, but it may require more than one treatment to achieve acceptable cosmetic results.

One to six sessions of ablative 2940 nm erbium YAG laser cleared pearly penile papules in 45 males. Wounds healed within two weeks. No recurrence, no scarring, and no residual pigmentation were noted at the one-year follow-up.

Fractional nonablative 1550 nm erbium laser is less painful than ablative devices and produces only microscopic skin damage which heals rapidly. Up to five treatment sessions were reported to be necessary to obtain a good cosmetic result.

Pulsed dye laser may be indicated in pearly penile papules treatment, as it is reported to give good aesthetic results, with a few side effects after one to three sessions.

Various groups have reported successful and complete clearance of PPP with CO₂ laser ablation. The high vascularity of penile tissue allows for rapid healing after laser-induced thermal injury, but this also predisposes the patient to bleed during the procedure. The continuous wave mode of the CO₂ laser provides better hemostasis and operative field visualization than the short pulse mode [rx]. Using the fractionated CO₂ laser, one group reported more than 90% resolution after a single treatment. Another group concluded that two to three treatments were sufficient to completely resolve lesions without adverse effects in both light and dark skin types. While the CO₂ laser exposes the underlying tissue, reepithelialization generally occurs within 5 to 7 days. Nevertheless, the procedure requires anesthesia and increases the risk of scarring and infection?. Additionally, postoperative management, including home dressing changes, can be inconvenient to patients. The CO₂ laser can also lead to postinflammatory pigmentation changes in dark skin types. Despite this fact, two groups reported complete ulcer?. সহজ বাংলা: শরীরের অস্বাভাবিক দাগ, ক্ষত বা ফোলা অংশ।" data-rx-term="lesion" data-rx-definition="A lesion is an abnormal area of tissue such as a spot, wound, patch, lump, or ulcer. সহজ বাংলা: শরীরের অস্বাভাবিক দাগ, ক্ষত বা ফোলা অংশ।">lesion? resolution with no adverse pigmentary events.

Using the ablative 2940-nm Er:YAG laser, Baumgartner treated 45 patients for one to six sessions. All lesions were successfully cleared with no adverse effects and no recurrence after 1 year. Notably, many of the patients in this study had prior failed treatment attempts with agents such as podophyllin, cryotherapy, and topical fluorouracil plus salicylic acid. Ablated areas healed within 2 weeks after treatment. Despite sustaining up to six laser sessions, no scarring or pigmentation changes were noted.

Fractional resurfacing with the 1550-nm erbium laser has shown complete clearance in one patient after five treatment sessions. Unlike ablative approaches, this laser was relatively painless and did not produce open wounds in the skin. Additionally, there was no ulcer?. সহজ বাংলা: শরীরের অস্বাভাবিক দাগ, ক্ষত বা ফোলা অংশ।" data-rx-term="lesion" data-rx-definition="A lesion is an abnormal area of tissue such as a spot, wound, patch, lump, or ulcer. সহজ বাংলা: শরীরের অস্বাভাবিক দাগ, ক্ষত বা ফোলা অংশ।">lesion? recurrence after 1 year